`Old-old` Living Beyond Nation`s Means

ARLINGTON, VA. — Tom Stevenson, who spent 46 years of his life drawing road maps to help others find their way, gave up driving six years ago when he came down with Parkinson`s disease.

``My daughter told me I would be losing my independence,`` he said.

``Well, I had rather lose my independence than kill somebody.``

Stevenson, 82, makes his way around the Madison Community Center for the Elderly with the aid of a walker and considerable courage. His only resources are Social Security, Medicare and a small pension, although his health bills are large. ``It takes all I got,`` he said.

Stevenson is part of the fastest-growing and most vulnerable segment of the nation`s population, those over 75, the ``old-old.`` This group is the most visible proof that America is growing older, requiring greater public and private resources to relieve a rising rate of national dependency.

In addition, while statistics show that the elderly as a group are as well off economically as younger Americans, a large number of older Americans who have meager incomes are being hurt by budget cutbacks. Federally subsidized housing programs have been slashed. Medicare recipients are being forced to put up more of their own money when hospitalized.

Budget reductions of the last four years represent the first time in U.S. history that the government has tried to come to grips with the rising costs caused by the aging of the population.

Social Security has been exempted from budget reductions required under the recently passed Gramm-Rudman balanced budget amendment, but the elderly may see cutbacks in other programs.

The costs associated with caring for the ``old-old`` is forcing a reassessment of many government policies helping the elderly, especially the Medicare program set up in 1965 to provide for the acute, short-term health-care needs of retired Americans.

Many experts believe that Medicare is in drastic need of overhaul. Most prefer converting it into a program to pay only for catastrophic illness or long-term health care, such as nursing homes.

Jerold Kieffer, former deputy commissioner of Social Security, called Medicare a ``paper shield`` and said that ``one of the real evils of the budget deficit is it discourages experimentation.`` He said good ideas to overhaul the Medicare system will have to be put on hold.

Yet, Dr. Otis Bowen, President Reagan`s secretary of health and human services, told the Senate Finance Committee he is making Medicare redesign one of his top priorities. He said that if recipients paid an extra monthly premium of $12, Medicare could provide an unlimited number of days in the hospital.

Now Medicare does not pay beyond the 150th day of hospitalization and beneficiaries must pay large amounts out of their own pocket after the 60th day of hospitalization.

Many elderly Americans are under the false impression that Medicare, when combined with the Part B premiums for physicians` care, will take care of most of their health needs.

The American Association of Retired People (AARP) came up with a startling finding when it asked its members how they would finance a nursing- home stay. The response: 79 percent said they would use Medicare to pay a portion of their expenses and 50 percent said they would use private insurance. The truth is that neither will pay for nursing-home care.

More than 40 percent of nursing-home costs are paid by patients themselves and most of the remainder is paid for by state Medicaid programs for the poor. Some elderly people must impoverish themselves in order to qualify for Medicaid and nursing-home care.

Bowen proposed that Congress vote to establish ``individual medical accounts,`` similar to individual retirement accounts, to which workers could make tax-deductible contributions over their lifetimes. The money would be used to pay for nursing-home care, if required.

The medical IRA also has been proposed by the CATO Institute, a think-tank with libertarian leanings.

Others believe that the Medicare reimbursement system must be changed fundamentally so that many specialists who use high-technology medicine are paid less than they are now for their services.

Dr. Robert Butler, chairman of the geriatrics department of Mt. Sinai Hospital in New York, said any revision of Medicare should emphasize shifting from acute short-term to chronic long-term care.

``It`s obvious that our society cannot get along with what I call Peter Pan medicine,`` he said. ``We must adapt our health-care system to the realities of change in the population.

``Eighty percent of all deaths occur after age 60, so different from the way it was 100 years ago. I think it can be done without great new sums of money, but it`s going to require tough decision-making, including some profound changes in reimbursement.``

These changes should focus on cutting reimbursement for specialists who are earning a great deal from Medicare, he said, adding that ``a lot of these procedures probably could be done by paraprofessionals.``